Información del artículo
Resumen
Objetivo
Valorar el papel de la resistencia a la insulina de forma independiente de la obesidad, en la determinación del riesgo cardiovascular entre mujeres con el síndrome de ovarios poliquísticos (SOPQ).
DiseñoEstudio transversal que examina las relaciones entre hiperinsulinemia,puntuaciones que componen el riesgo cardiovascular y prevalencia de factores de riesgo individuales entre mujeres delgadas y obesas con SOPQ y controles sanos.
PacientesUn total de 30 mujeres con SOPQ definido clínicamente y 25 controles sanos por la edad no seleccionados.
IntervencionesMediciones clínicas y antropomórficas y determinaciones de los niveles de insulina y lípidos.
Mediciones de los resultados principalesInsulina sérica en ayunas y puntuación de riesgo cardiovascular.
ResultadosLas mujeres hiperinsulinémicas con SOPQ conllevaban un mayor riesgo cardiovascular que sus homólogas normoinsulinémicas,las cuales tenían un mayor riesgo que las mujeres control (p < 0,05 por análisis de covariancia). Además de los cambios en los lípidos esperados por la resistencia a la insulina (valores elevados de triglicéridos y bajos de colesterol unido a lipoproteínas de alta densidad),hubo un exceso de colesterol unido a lipoproteínas de baja densidad entre las mujeres con SOPQ (p < 0,01) por análisis de la covariancia. En el mismo rango de índice de masa corporal,las mujeres con SOPQ tenían mayor resistencia a la insulina que los controles,sugiriendo que tanto el SOPQ,por sí mismo,como el índice de masa corporal contribuyen a la resistencia a la insulina observada.
ConclusionesNuestros resultados apoyan la hipótesis de que la resistencia a la insulina en el SOPQ es un determinante del riesgo cardiovascular en conjunto,con independencia de la obesidad. El mecanismo de esta relación es incierto y es objeto de investigación en marcha.
Summary
Objective
To asses the role of insulin resistance, independent of obesity, in determining cardiovascular risk among women with tile polycystic ovarian sindrome (PCOS).
DesignCross-sectional study examining the relations-hips between hyperinsulinemia, composite cardiovascular risk scores, and prevalence of individual risk factors among lean and obese women with PCOS and healthy controls.
Patients30 women with clinically defined PCOS and 25 unselected healthy age-matched controls.
InterventionsClinical and anthropomorphic measurements and laboratory determinations of insulin and lipid levels.
Main outcome measuresFasting serum insulin and a cardiovascular risk score.
ResultsHyperinsulinemic women with PCOS carried more cardiovascular risk than their normoinsuli-nemic counterparts, who in turn had than tre control women (p < 0.05 by analysis of covariance). In addition to the lipid changes expetec with insulin resistance (high triglyceride and low HDL cholesterol levels), the was and excess of LDL cholesterol among the women with PCOS (p < 0.01 by analysis of covariance). Across the range of body mass index, women with PCOS had greater insulin resistance than controls, suggesting that PCOS itself and body mass index both contribute to the observed insulin resistance.
ConclusionsOur data support the hypothesis that insulin resistance in PCOS is a determinant of overall cardiovascular risk independent obesity. The mechanism of this relationship remains uncertain and is the subjects of ongoing research.
El Texto completo está disponible en PDF
Bibliografía
[1.]
S. Franks.
Polycystic ovary sindrome.
N Engl J Med, 333 (1995), pp. 853-859
[2.]
VT Goudas, DA. Dumesic.
Polycystic ovary sindrome.
Endocrinol Metab Clin North Am, 26 (1997), pp. 893-912
[3.]
R. Homburg.
Síndrome de los ovarios poliquísticos: consenso y controversia.
Ovario poliquístico,
[4.]
HS. Jacobs.
Definiciones y diagnóstico del síndrome de ovarios poliquísticos.
Ovario Poliquístico, (1998),
[5.]
J. Balasch.
Síndrome de los ovarios poliquísticos: de la ginecología a la endocrinología o hacia una concepción unitaria.
Endocrinología, 46 (1998), pp. 251-252
[6.]
IF Stein, ML. Leventhal.
Amenorrhea associated with bilateral polycystic ovaries.
Am J Obstet Gynecol, 29 (1935), pp. 181-191
[7.]
A. Cheréau.
Mémories pour servir a l’étude des maladies des ovaries.
[8.]
AA Gadir, MS Khatim, RS. Mowafi.
Implications of ultrasonically diagnosed polycystic ovaries. I. Correlations with basal hormonal profiles.
Hum Reprod, 7 (1992), pp. 453-457
[9.]
R Rebar, HL Judd, SSC Yen, O Vanderverg, F. Naftolin.
Characterization of the inappropiate gonadotropin secretion in polycystic ovary syndrome.
J Clin Invest, 57 (1976), pp. 1320-1329
[10.]
CR Khan, JS Flier, RS Bar, JA Archal, P. Gorden.
The syndromes of insulin resistance and acanthosis nigricans. Insulin receptor disorders in man.
N Engl J Med, 294 (1976), pp. 739-745
[11.]
GA Burghen, JR Givens, AE. Kitabchi.
Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease.
J Clin Endocrinol Metab, 50 (1980), pp. 113-116
[12.]
A. Dunaif.
Insulin resistance and the polycystic ovary syndrome: Mechanism and implications for pathogenesis.
Semin Reprod Endocrinol, 18 (1997), pp. 774-800
[13.]
JE. Nestler.
Role of hyperinsulinemia in the pathogenesis of the polycystic ovary syndrome, and its clinical implications.
Semin Reprod Endocrinol, 15 (1997), pp. 111-122
[14.]
M Swanson, EE Saverbrie, PL. Cooperberg.
Medical implications of ultrasonically detected polycystic ovaries.
J Clin Ultrasound, 9 (1981), pp. 219-222
[15.]
J Adams, S Franks, DW Polson, HD Masson, N Abdulwahid, HS. Jacobs.
Multifollicular ovaries: clinical and endocrine features and response to pulsatile gonadotropin releasing hormone.
Lancet, 2 (1985), pp. 1375-1378
[16.]
S. Franks.
Factores genéticos en la etiología del síndrome de los ovarios poliquísticos.
Ovario poliquístico, pp. 45-58
[17.]
López LC Tejerizo, Sánchez A García, Sánchez MH García, García A Tejerizo, Egido J. Moro.
Hiperandrogenismos:etiología.
Cienc Ginecol, 4 (2000), pp. 7-20
[18.]
RB Barnes, RL. Rosenfield.
Polycystic ovary syndrome pathogenesis and treatment.
Ann Intern Med, 110 (1989), pp. 386-399
[19.]
D. Guzick.
Polycystic ovary syndrome: symptomatology, pathophysiology, and epidemiology.
Am J Obstet Gynecol, 179 (1998), pp. 589-593
[20.]
L Ibáñez, N Potau, M Zampolli, N Prat, M Gussnyé, OP Saenger, et al.
Source localization of androgen excess in adolescent girls.
J Clin Endocrinol Metab, 79 (1994), pp. 1978-1984
[21.]
L Ibáñez, N Potau, A. Carrascosa.
Hiperandrogenismo.
Tratado de endocrinología pediátrica y de la adolescencia, pp. 763-778
[22.]
G Creatsas, D Loutradis, E Deligeoroglu, N. Goumalatsos.
Valutazione e tratamiento delle adolescenti con oligomenorrea.
Gin Ing Adolesc, 4 (1988), pp. 99-105
[23.]
GM Cristman, JF Randolph, RP Kelch, JC. Marshall.
Reduction of gonadotropinreleasing hormone pulse frecuency in associated with subsequent selective follicle-stimulating hormone secretion in women with polycystic ovarian disease.
J Clin Endocrinol Metab, 72 (1991), pp. 1278-1285
[24.]
S. Franks.
Polycystic ovary syndrome: a changing perspective.
Clin Endocrinol (Oxf, 30 (1989), pp. 459-470
[25.]
GS Conway, JW Honour, HS. Jacobs.
Heterogeneity of the polycystic ovary syndrome: clinical, endocrine and ultrasound features in 556 patients.
Clin Endocrinol (Oxf, 30 (1989), pp. 470-477
[26.]
LC Tejerizo-López, JA Pérez-Escanilla, Moro F Corredera, Deiros AL Teijelo, Egido J Moro, Sánchez MM Sánchez, et al.
Hiperandrogenismo, insulinorresistencia e hiperinsulinismo.
Cienc Ginecol, 4 (2000), pp. 40-58
[27.]
JE. Nesler.
Insulin regulation of human ovarian androgens.
Human Reprod, 12 (1997), pp. 53-62
[28.]
A Dunaif, KR Segal, DR Shelley, O Green, A Dobransky, T. Licholai.
Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome.
Diabetes, 41 (1992), pp. 1257-1266
[29.]
D Willis, H Mason, C Gilling-Smith, S. Franks.
Modulation by insulin by follicle-stimulating hormone and luteinizing hormone actions in human granullosa cells of normal and polycystic ovaries.
Clin Endocrinol Metab, 81 (1996), pp. 302-309
[30.]
A Dunaif, DT. Finegood.
Betacell dysfunction independent of obesity and glucose intolerance in the polycystic ovary syndrome.
J Clin Endocrinol Metab, 81 (1996), pp. 942-947
[31.]
EL Bierman, JA. Glomset.
Trastornos del metabolismo de los lípidos.
Endocrinología, pp. 1578-1620
[32.]
Argilaga C. Soler.
Lipoproteínas plasmáticas. Consideraciones fisicoquímicas y metabólicas.
Hiperlipoproteinemias. Clínica y tratamiento, pp. 1-15
[33.]
P. Libby.
Aterosclerosis.
Principios de medicina interna. I, 14, pp. 153-643
[34.]
HN Ginsberg, IJ. Goldberg.
Trastornos del metabolismo de las lipoproteínas.
Principios de medicina interna. II, 14, pp. 243-244
[35.]
Hunninghake D, editor. Lipid disorders. Med Clin North Am 1994; 78
[36.]
EJ Schafer, RI. Levy.
Pathogenesis and management of lipoprotein disorders.
N Engl J Med, 312 (1985), pp. 1300-1310
[38.]
O. Schonfeld.
Disorders of lipid transport. Update1983.
Cardiovasc Dis, 26 (1983), pp. 89-108
[39.]
R. Segura.
Composición y estructura de las lipoproteínas.
Lipoproteinas plasmáticas y aterosclerosis coronaria, pp. 29-70
[40.]
RA. Wild.
Metabolismo de lípidos e hiperandrogenismo.
Gin Obst Gin, 34 (1991), pp. 829-835
[41.]
LC Tejerizo, MJ Doyague, MJ Velasco, Iglesias A García, J Hernández, M Cabezas, et al.
Esteroides sexuales, lípidos y lipoproteínas. Riesgo cardiovascular.
Prog Obst Gin, 35 (1992), pp. 401-420
[42.]
LC Tejerizo, JL Lanchares, Iglesias A García, Hernández J Hernández, Sánchez MH García, JD. Redondo.
Andrógenos y perfil lipídico.
Clin Invest Gin Obstet, 20 (1993), pp. 455-469
[43.]
DH Blankenhorn, P Alaupovic, MS Wickman, HP Chin, SP. Azen.
Prediction of angiographic change in native human coronary arteries and aortocoronary bypass grafts.
Circulation, 81 (1990), pp. 470-476
[44.]
P Alaupovic, DH. Blankerhorn.
Characterization of potencially atherogenic triglyceride-rich lipoprotein particles.
Clin Wochensher, 69 (1990), pp. 38-45
[45.]
M Guinot, Gerique J Gómez, Bermúdez R Montañes, A Cabero, J. Calaf.
Perfil lipídico en el síndrome de ovarios poliquísticos.
1. Efectos de la supresión ovárica con buserelin, 36 (1989), pp. 61-69
[46.]
E Dahlgren, PO Janson, S Johansson, L Lepidus, A. Orden.
Polycystic ovary syndrome and risk for myocardial infarction. Evaluated from a risk factor model based on a prospective population study a women.
Acta Obstet Gynecol Scand, 71 (1992), pp. 599-604
[47.]
PS Conway, R Agrawal, DJ Betteridge, HS. Jacobs.
Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome.
Clin Endocrinol, 37 (1992), pp. 119-125
[48.]
E Talbott, D Guzick, A Clerici, S Berga, K Deter, K Weimer, et al.
Coronary heart disease risk factors in women with polycystic ovary syndrome.
Arterioscler Thromb Vasc Biol, 15 (1995), pp. 821-826
[49.]
DS. Guzick.
Cardiovascular risk in women with polycystic ovarian syndrome.
Semin Reprod Endocrinol, 14 (1996), pp. 45-49
[50.]
LC Tejerizo-López, J Moro, MM Sánchez, RM García, AI Teijelo, García A Tejerizo, et al.
Síndrome de ovarios poliquísticos y riesgo cardiovascular.
Clin Invest Gin Obst, 27 (2000), pp. 80-90
[51.]
D Ferriman, JD. Gallway.
Clinical assessment of body hair women.
J Clin Endocrinol Metab, 24 (1961), pp. 1440-1448
[52.]
J Adams, DW Polson, S. Franks.
Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism.
Br Med J, 9 (1986), pp. 102-121
[53.]
H Yen, W Futterweit, J. Thornton.
Polycystic ovarian disease: us feature in 104 patients.
Radiology, 163 (1987), pp. 111-116
[54.]
Y Ardaens, Y Robert, L Lemaitre, P Fossati, P. Dewailly.
Polycystuc ovarian disease: contribution of vaginal endosonagraphy and reassessment of ultrasonic diagnosis.
Fertil Steril, 55 (1991), pp. 1062-1068
[55.]
TD Pache, JW Wladimiroff, WC Hop, BC. Fauser.
How to discriminate between normal and polycystic ovaries: transvaginal US study.
Radiology, 183 (1992), pp. 421-423
[56.]
R Fox, R Corrigan, S Okada, Musa A Abu, K Yoshino, M. Kiato.
Morphological assessment of polycystic ovary using transvaginal ultrasound.
Hum Reprod, 8 (1993), pp. 844-849
[57.]
G Creatsas, E Hassan, E Deligloroglu, A Tolis, D. Aravantinos.
Treatment of polycystic ovarian disease during adolescence with ethinylestradiol/ciproterone acetate versus a DrTr6LHRH analog.
Int J Gynecol Obstet, 42 (1993), pp. 147-153
[58.]
M Botella, L Bretón, E Palacio, P. Rodríguez.
Ovarios poliquísticos.
Diagnóstico y tratamiento en endocrinología, pp. 403-408
[59.]
J Zaidi, S Campbell, R Pittrof, R KyeiMensah, HS Jacobs, SI. Tan.
Ovarian stromal bloodflow changes in women with polycystis ovaries. A possible new marker for ultrasound diagnosis?.
Human Reprod, 10 (1995), pp. 1992-1996
[60.]
A Bermejo, Martín P. Sánchez.
Aportación de la ecografía al síndrome de ovarios poliquísticos.
Prog Diagn Prenat, 11 (1999), pp. 449-460
[61.]
Salvadó J Salas, Carañas R. Trallero.
Nutrición.
Medicina interna II, 13, pp. 1973-2005
[62.]
GA. Bray.
Obesidad.
Harrison. Principios de medicina interna. J, 14, pp. 515-524
[63.]
GA. Bray.
Clasificación y valoración de las obesidades.
Clínicas Médicas de Norteamérica, 1 (1989), pp. 191-218
[64.]
García S. Durán.
Obesidad.
Endocrinología y nutrición, pp. 255-273
[65.]
WI. Rosner.
Sex-hormone-binding globulin saturation analysis.
J Clin Endocrinol Metab, 34 (1972), pp. 83-988
[66.]
Toda I Ibáñez, N. Potau.
Hiperandrogenismos ováricos peripuberales.
Hiperandorgenismos,
[67.]
MI New, F Lorenze, AJ Lerner, B Kohn, SE Oberfleld, A Pollack, et al.
Genotyping steroid 21-hydroxilase deficiency: hormonal reference data.
J Clin Endocrinol Metab, 57 (1983), pp. 320-326
[68.]
Espinoza J Rodríguez, Alsina J. Calaf.
Estrategias para el escrutinio de formas no clásicas de hiperplasia suprarrenal congénita por deficiencia de P 450 c21 en mujeres hiperan drogénicas.
Med Clin (Barc, 103 (1994), pp. 645-651
[69.]
Espinosa J. Hiperandrogenismo. Rodríguez.
Diagnóstico bioquímico.
Hiperandrogenismos,
[70.]
Parera L Audí, Ybern ML. Granada.
Recomendaciones para la exploración hormonal del hirsutismo.
Quim Clin, 15 (1996), pp. 450-455
[71.]
Gerique JA Gómez, JM. Rodríguez.
Determinación de colesterol de HDL mediante métodos de precipitación. Estudio de los posibles factores que pudieran modificar el resultado final en cada uno de ellos.
Quim Clin, 3 (1984), pp. 249-261
[72.]
WT Friedewald, RI Levi, DS Fredickson.
Estimation of plasma low density lipoprotein cholesterol concentration whithout use of the preparative ultracentrifugation.
Clin Chem, 18 (1972), pp. 499-509
[73.]
Durán RS Padrón, GM Fernández, Díaz J Mas, R González, JOA. Seuc.
Insulinorresistencia e hiperinsulinismo en mujeres con hiperandrogenismo.
Endocrinología, 43 (1996), pp. 332-336
[74.]
KJ Mather, F Kwan, B. Corenblum.
Hyperinsulinemia in polycystic ovary sindrome correlates with increased cardiovascular risk independent of obesity.
Fertil Steril, 73 (2000), pp. 150-156
[75.]
R. Kahn.
Consensus development conference on insulin resistance (American Diabetes Association.
Diabetes Care, 21 (1998), pp. 319-414
[76.]
RS Legro, D Finegool, A. Dunaif.
A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycycstic ovary syndrome.
J Clin Endocrinol Metab, 83 (1998), pp. 2694-2698
[77.]
KM Rexrode, CH HenneKens, EE Walters, GA Colditz, MJ Stampfer, et al.
Abdominal adiposity and coronary heart disease in women.
JAMA, 280 (1998), pp. 1843-1848
[78.]
PF Wilson, RB D’Agostino, D Levy, AM Belaner, H Silbershatx, WB. Kannel.
Prediction of coronary heart disease using risk factor categories.
Circulation, 97 (1998), pp. 1837-1847
[79.]
Diabetes Association. American.
Screening for type 2 diabetes (position paper.
Diabetes Care, 22 (1999), pp. 520-523
[80.]
EJ. Schafer.
Hyperlipoproteinemias and other lipoprotein disorders.
Principles and practice of endocrinology and metabolism, pp. 1229-1249
[81.]
MR. Henzl.
Hormonas anticonceptivas y su uso clínico.
Endocrinología de la reproducción. Fisiología, fisiopatología y manejo clínico, pp. 833-855
[82.]
RS. Rittmaster.
Hiperandrogenismo.
Ginecología, pp. 405-437
[83.]
DR Illinwoeth, PB Duell, WE. Connor.
Disorders of lipid metabolism.
Endocrinology metabolism, pp. 1315-1403
[84.]
Sánchez A. Cano.
Repercusiones metabólicas del hiperandrogenismo.
Hiperandrogenismos,
[85.]
P Mauvais-Jarvis, P. Leconte.
Ovarios poliquísticos.
Ginecología endocrinológica, pp. 312-323
[86.]
I. Mowszowicz.
Hirsutismo.
Ginecología endocrinológica, pp. 353-372
[87.]
SSC. Yen.
Anovulación crónica causada por trastornos endocrinos periféricos.
Fisiología, fisiopatología y manejo clínico, pp. 603-657
[88.]
Gl. Hammond.
Molecular properties of corticosteroid binding and the sexsteroid proteins.
Endocr Rev, 11 (1990), pp. 65-79
[89.]
W. Rosner.
The functions of corticosteroid-binding globulin and sex hormonebinding globulin: recent advances.
Endocr Rev, 2 (1990), pp. 80-91
[91.]
CM Mendel.
The free hormone hypothesis a physiological based mathematical model.
Endocr Rev, 10 (1989), pp. 232-274
[92.]
R Fox, E Corrigan, PA Thomas, MG. Gull.
The diagnosis of polycystic ovaries in women with oligomenorrhoea: predictive power of endocrine test.
Clin Endocrinol, 34 (1991), pp. 127-131
[93.]
Puig A Vidal, Torres M Muñoz, Jiménez F. Escobar.
Hiperinsulinemia en los estados de hiperandrogenismos.
Endocrinología, 39 (1992), pp. 13-16
[94.]
Gómez JJ Espinós, i Alsina J. Calaf.
Hiperandrogenismo, hiperinsulinismo e insulinorresistencia en el síndrome de ovarios poliquísticos.
Hiperandrogenismos,
[95.]
GS. Conway.
Resistencia a la insulina y obesidad en el síndrome de los ovarios poliquísticos.
Ovario poliquístico,
[96.]
M. Birdsall.
Secuelas a largo plazo relacionadas con el síndrome de los ovarios poliquísticos.
ovario poliquístico,
[97.]
LC Tejerizo-López, AL Teijelo, MM Sánchez-Sánchez, Robles RM García, J Moro, JA Pérez-Escanilla, et al.
Hiperandrogenismos femeninos. Insulinorresistecia e hiperinsulinismo.
Clin Invest Gin Obst, 27 (2000), pp. 266-275
[98.]
RA Wild, B Grubb, A Hart, JJ Van Nort, W Bachman, M. Bartholomew.
Clinical sings of androgen excess as risk factors for coronary artery disease.
Fertil Steril, 54 (1990), pp. 255-260
[99.]
L Anttila, YQ Ding, K Ruutiainen, R Erkkola, K Irja, J. Huhtaniemi.
Clinical features and circulating gonadotrophin, insulin and androgen interactions in women with polycystic ovarian disease.
Fertil Steril, 53 (1991), pp. 1057-1061
[100.]
LC Tejerizo, JL Lanchares, MJ Velasco, MJ Doyague, S Luna, Iglesias A García, et al.
Síndrome de ovarios poliquísticos: niveles plasmáticos de andrógenos, insulina, gonadotropinas y sus correlaciones.
Clin Invest Gin Obstet, 20 (1993), pp. 388-399
[101.]
LC Tejerizo, A García, S Luna, MJ Doyague, J Hernández, JL. Lanchares.
Síndrome de ovarios poliquísticos: análisis de las correlaciones entre niveles de andrógenos e insulina.
Prog Obstet Ginecol, 36 (1993), pp. 342-345
[102.]
P. Trinder.
Determination of glucose in blood using glucose oxidase with and alternative oxygen acceptor.
Ann Clin Biochem, 6 (1989), pp. 24-27
[103.]
V Toscano, P Bianchi, R Balducci, R Guglielmi, A Mangiantini, C Lubrano, et al.
Lack of lineal relationship between hyperinsulinemia and hyperandrogenism.
Clin Endocrinol, 36 (1992), pp. 197-202
[104.]
López LC Tejerizo, Pérez JL Lanchares, Iglesias A. García.
Síndrome de ovarios poliquísticos. Hiperandorgenismo e hiperinsulinemia.
Toko Gin Pract, 52 (1993), pp. 319-327
[105.]
R. Garner.
The impact of obesity reproductive function.
Semin Reprod Endocrinol, 8 (1990), pp. 32-43
[106.]
DW. Foster.
Diabetes Mellitus.
Harrison. Principios de Medicina Interna. II, 14, pp. 2341-2365
[107.]
RA Wild, P Alaupovic, IJ. Parker.
Lipid and apolipoproteins abnormalities in hirsute women. I. The association with insulin resistance.
Am J Obstet Gynecol, 167 (1992), pp. 1191-1197
[108.]
RL. Barbieri.
Polycystic ovarian disease.
Am J Med, 42 (1991), pp. 199-204
[109.]
GS Conway, R Agrawal, DJ Betteridge, HS. Jacobs.
Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome.
Clin Endocrinol, 37 (1992), pp. 119-125
[110.]
M Birdsall, CM Farquhar, H. White.
Association between polycystic ovaries and extent of coronary artery disease in women having cardiac catherization.
Ann Intern Med, 126 (1997), pp. 32-35
[111.]
T Pierpoint, PM McKeigue, AJ Issacs, SH Wild, NS. Jacobs.
Mortality of women with polycystic ovary syndrome at longterm followup.
J Clin Epidemiol, 51 (1998), pp. 581-586
[112.]
GM Prelevic, T Beljic, L Balint-Peric, J. Ginsburg.
Cardiac flow velocity in women with the polycystic ovary syndrome.
Clin Endocrinol, 43 (1995), pp. 677-681
[113.]
DS Guzick, EO Talbott, K Sutton-Tyrrell, HC Herzog, LH Kuller, SK. Wolfson.
Carotid atherosclerosis in women with polycystic ovary syndrome: initial results from a case-control study.
Am J Obstet Gynecol, 174 (1996), pp. 1224-1229
[114.]
G Paradisi, HO Steinberg, M Shepard, AD. Baron.
Polycystic ovary syndrome is associated with endothelial dysfunction [resumen].
Diabetes, 47 (1998), pp. 309
[115.]
A Vidal-Puig, Torres M Muñoz, E Jodar-Gimeno, C GarcíaCalvente, P Lardelli, ME Ruiz-Requena, et al.
Hyperinsulinemia in polycystic ovary sindrome: relationship to clinical and hormonal factors.
Clin Invest, 72 (1994), pp. 853-857
[116.]
RA. Wild.
Metabolic aspects of polycystic ovary syndrome.
Semin Reprod Endocrinol, 15 (1997), pp. 105-110
[117.]
MJ Graf, Cj Richards, V Brown, L Meissner, A. Dunaif.
The independet effects of hyperandrogenaemia, hyperinsulinaemia, and obesity on lipid and lipoprotein profiles in women.
Clin Endocrinol, 33 (1990), pp. 119-131
[118.]
GM. Reaven.
Role of insulin resistance in human disease.
Diabetes, 37 (1988), pp. 1595-1607
[119.]
J Holte, G Gennarelli, C. Berne.
Elevated blood pressure in women with polycystic ovary syndrome a sing of a prehipertensive state?.
J Hyperte, 11 (1995), pp. 23-28
[120.]
A Dunnaif, M Graf, J Mandeli, V Laumas, A. Dobrjansky.
Characterization of group of hyperandrogenic women with acanthosis nigricans, impaired glucose tolerance, and for hyperinsulinemia.
J Clin Endocrinol Metab, 65 (1987), pp. 499-507
[121.]
J Slowinska-Srzednicka, S Zgliczynski, M Wierzbickí, M Srzendicki, U StopinskaGluszak, W Zgliczynski, et al.
The role hyperinsulinemia in the development of lipid disturbances in nonobese and obese women with the polycystic ovary syndrome.
J Endocrinol Invest, 14 (1991), pp. 569-575
[122.]
DA Ehrmann, RB Barnes, RL Rosenfield, MK Cavaghan, J. Imperial.
Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome.
Diabetes Care, 22 (1999), pp. 141-146
[123.]
P Campbell, J. Gerich.
Impact of obesity on insulin action in volunteers with normal glucose tolerance: demonstration of a threshold for the adverse effect of obesity.
J Clin Endocrinol Metab, 70 (1990), pp. 1114-1118
[124.]
RS Rittmaster, N Deshwal, L. Lehman.
The role of adrenal hyperandrogenism, insulin resistance, and obesity in the pathogenesis of polycystic ovarian syndrome.
J Clin Endocrinol Metab, 76 (1993), pp. 1295-1300
[125.]
A Dunaif, KR Segal, W Futterweit, A. Drobrjansky.
Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome.
Diabetes, 38 (1989), pp. 1165-1174
[126.]
A. Garg.
Dyslipoproteinemía and diabetes (review.
Endocrinol Metabo Clin North Am, 27 (1998), pp. 613-625
[127.]
MJ Stampfer, GA Colditz, WC. Willett.
Menopause and heart diasease. A review.
Ann NY Acad Sci, 592 (1990), pp. 193-203
[128.]
SO Skouby, LF. Andersen.
Estrógenos, gestágenos y glucosa. Metabolismo en mujeres post-menopáusicas.
pp. 85-92
[129.]
GM. Reaven.
Pathophysiology of insulin resistance in human disease.
Physiol Rev, 75 (1995), pp. 473-486
[130.]
JD Dean, CJH Jones, J Hutchinson, JR. Henderson AH. Peters.
Hyperinsulinemia and microvascular angina.
Lancet, 337 (1991), pp. 456-457
[131.]
D Figuerola, E. Reynals.
Diabetes mellitus.
Medicina interna. II, 13, pp. 1933-1969
[132.]
V Toscano, P Bianchi, R Barducci, R Guglielmi, A Mangiantini, C Lubrano, et al.
Lack of linear relationship between hyperinsulinemia and hyperandrogenism.
Clin Endocrinol, 36 (1992), pp. 197-202
[133.]
RA. Wild.
Obesity, lipids, cardiovascular risk, and androgen excess.
Am J Med, 98 (1995), pp. 275-325
[134.]
M Ciampelli, AM Fulghesu, F Cucinelli, V Pavone, E Ronsisvalle, M Guido, et al.
Impact of insulin and body mass index on metabolism and endocrine variables in polycystic ovary syndrome.
Metabolism, 48 (1999), pp. 167-172
[135.]
PF Wilson, RB D’Agostino, D Levy, AM Belanger, H Sillbershatz, WB. Kannel.
Prediction of coronary heart disease using risk factor categories.
Circulation, 97 (1998), pp. 1837-1847
[136.]
R. Khan.
Consensus development conference on insulin resistance (American Diabetes Association.
Diabetes Care, 21 (1998), pp. 3104
[137.]
A Parra, A Ramírez, M Espinosa, ratio. insulin.
An index to differentiale normo from hyperinsulinemic woen with polycystic ovary syndrome.
Rev Invest Clin, 46 (1994), pp. 363-368
[138.]
RS Legro, D Finegool, A. Dunaif.
A fasting glucose to insulin ratio is a useful measure of insulin sensivity in women with polycystic ovary syndrome.
J Clin Endocrinol Metab, 83 (1998), pp. 2694-2698
Copyright © 2001. Elsevier España, S.L.. Todos los derechos reservados
